In this article: Pets get anxious too Virtual therapy tames terrors Also this week: How to spot an anxious child How to help an anxious loved one

Join our online chat! Join our Web Chat on anxiety with psychotherapist Jerilyn Ross, president of the Anxiety Disorders Association of America (www.adaa.org), in a live, one-hour chat this Monday, Oct. 2, at 1 p.m. ET

Facing your fear

Anxiety is America's No. 1 mental health problem. It costs billions and ruins lives. And it's on the rise. Why? "It's a scary place and time," an expert says.

by Mary Ellin Lerner

had Dyer was driving home from the beach on a peaceful summer afternoon when he was seized by panic. His hands shook, his stomach tightened, he thought he'd pass out. "I'd never experienced such weird sensations. I was sure I was dying," says the 26-year-old car salesman from Annapolis, Md. A few days later, another episode. Then several more. He was terrified to leave home for fear of collapsing in public. Dyer had a brain scan, an ear exam and an electrocardiogram, but the physicians found nothing. Desperate, he called a psychological clinic and got his answer: He was suffering from an anxiety disorder.

Dyer's symptoms are surprisingly common. Anxiety disorders are the No. 1 mental health problem in the United States, affecting at least 19 million people ages 18 to 54 each year, or 13% of adults, according to the National Institute of Mental Health, which this fall launches multimillion-dollar research into anxiety and mood disorders. Anxiety is also the leading mental health problem among the trick-or-treat set, affecting 13 million youngsters ages 9 to 17. The cost of this disorder: more than $42 billion a year in doctor bills and workplace losses. And those are conservative, low-ball numbers, experts say.

"All of us know someone with an anxiety disorder -- in our family, at work, among our friends," says psychotherapist Jerilyn Ross, president of the Anxiety Disorders Association of America.

What's worse, the problem is growing. A study by the World Health Organization shows that the odds of developing an anxiety disorder have doubled in the past four decades.

Why? "A lot of it has to do with the world in which we live," says Harvard Medical School epidemiologist Ronald Kessler, who co-authored the WHO study. "It's a scary place and time. People are moving to strange cities, taking jobs in new industries; there's a lot of uncertainty about the future. Bad things that happen to people are on the rise. Look at the evening news: murders, car accidents, terrorist bombs. This stuff is out there in the popular imagination and making us worried."

Anxious rapper: Michael McLeer's panic attacks put him in a band of 19 million adults with anxiety disorders.

Anxious celebs: Kim Basinger, panic attacks Katie Couric, fear of heights The NFL's Earl Campbell, panic attack Donny Osmond, social anxiety Howard Stern, obsessive-compulsive disorder Anxious roles: (recipients of an award from the Anxiety Disorders Association of America) Robert De Niro for Analyze This Jack Nicholson for As Good As It Gets Jim Carrey for The Truman Show

Consider these real scenarios: a man so anxious about driving over a bridge he asks his wife to shut him in the trunk of the car before crossing, a woman so fearful of heights she won't befriend anyone who lives above the 10th floor, a guy so nervous about using public restrooms he needs a therapist to accompany him to the toilet and talk him through it, a woman so beset by anxieties she wants to sneak into a morgue and contemplate death.

Edginess is epidemic. Turn on the TV this month and you'll catch a Discovery Health Channel series on folks who fear everything from bees to clowns. Switch to C-SPAN and you might see Congress considering a new bill to require insurance coverage for several types of anxiety. Click onto the Internet and join the 21.6 million Americans who visited the Web site of the Anxiety Disorders Association of America (www.adaa.org) in 1999, up from 500,000 in 1997.

Anxiety disorders are not one ailment but a spectrum of ills:

• 4 million Americans endure a constant state of fretfulness called generalized anxiety disorder.
• 11.5 million of us are phobics, spending half our lives steering clear of a critter or situation that makes us quake.
• 3.5 million war veterans, crime victims and others with horrifying experiences struggle with the persistent vigilance and terror of post-traumatic stress disorder.
• 1.5 million, like Chad Dyer, fight episodes of heart-pounding, stomach-churning anxiety known as panic attacks.
• 2.5 million suffer from obsessive-compulsive disorder (OCD), in which nightmarish thoughts are kept at bay with rituals such as incessant hand washing and housecleaning.

TV host Marc Summers (the Food Network's It's a Surprise and the History Channel's History I.Q.) endured OCD for decades before he was treated with medication and therapy. As a child, Summers passed Sunday afternoons alphabetizing his collection of Golden Books and making sure pictures of his idol, Johnny Carson, were spaced evenly on his bulletin board. As an adult, he spent leisure time combing the fringe on carpets in his Los Angeles home."I believed everything in my life had to be absolutely perfect," says Summers, who traces his OCD back to a grandmother who taught him to polish the chrome on her breakfast table. "It's a feeling in your gut that things are jumbled and if you straighten things up the feeling will go away. I knew it was strange. I hated it. I tried to hide it."

Covering up is common for people who feel embarrassed and fear being labeled as crazy, says Mary Guardino, founder of Freedom From Fear, an advocacy group for victims of anxiety disorders and depression. Guardino suffered from panic attacks for 20 years before she found treatment. "I was very active in my community, I was president of the PTA, but I had this secret life that no one knew about. I couldn't drive my car for more than two blocks. I couldn't get on a plane without drinking. I'd have panic attacks in stores and leave my groceries on the counter. Once I even left my car on a bridge and fled. Somehow I learned to function with these terrible impairments. But it was humiliating."

Many victims of anxiety disorders lead very limited lives, cloistered at home for weeks or years, passing up careers or friendships to escape stress and fear. "The human costs of anxiety are astronomical, among the highest of any illness," Kessler says. "Some people with anxiety disorders give up on going to college. They give up going to work. They never get married. Before you know it, they're inside their homes, never going out. And you can't rewind the clock to make up these losses."

Michael McLeer, 30, a rap artist and graphic designer from Brooklyn, N.Y., became so paralyzed by panic attacks that he refused to leave his home. When he finally showed up at an anxiety clinic, he felt ashamed. "I thought to myself, 'I must be a real wimp, what are people going to think of me?' "

He found out that intense anxiety is not a sign of cowardice but a serious ailment with biological and psychological roots.

For most people, fear is a healthy physical and emotional response that alerts us to real danger and prepares us for "fight or flight." In response to a threat, our senses fire off urgent signals to the brain. One message tells the cerebral cortex, the thinking part of the brain, what the threat is. Another signal goes to a tiny structure called the amygdala, which commands the heart to pump blood to the muscles for quick action and sends stress hormones and glucose into the bloodstream for extra energy. Finally, a memory of the frightening event and response is imprinted on the brain. Now, the body is primed to respond with fear to whatever triggered the reaction.

"With anxiety disorders, you get a false alarm," says David H. Barlow, Ph.D., director of the Center for Anxiety and Related Disorders at Boston University. People with anxiety disorders don't need grizzly bears or knife-wielding assailants to fuel their fear. A dentist or daddy longlegs will do just as well, thanks to the fear memory imprinted on the brain, ready to fire again and again in response to the same stimulus.

While scientists don't understand exactly what triggers the false alarms, they believe it is a complex mix of genetics, brain chemistry and psychology.

Recent studies show that anxiety disorders probably are inherited. "Families react to stress in similar ways," Barlow says. "Some get headaches, others get upset stomachs, others react with hypertension and some react with false alarms."

Scientists are studying the biochemistry of anxiety at the new National Institute of Mental Health center in Rockville, Md., and in hundreds of NIMH-sponsored studies nationwide. Using PET and MRI devices, researchers peer into the brains of people with anxiety disorders and gather evidence that brain chemicals may function abnormally in the chronically anxious.

"We are just at the beginning," says NIMH director Steven Hyman, M.D. "I want to find out how the signals go wrong, why a Vietnam veteran hearing a traffic helicopter thinks he's under attack again. We need to know where that tracks in the brain. We would like to develop brain imaging tests to diagnose anxiety disorders and improve therapy."

Other studies will explore childhood experiences. Research on primates shows that monkeys separated from their mothers at an early age are more fearful and their stress hormones fire more readily. "Their brains are continually alert for uncontrollable unpredictable events, and they are always in a state of readiness for danger," Barlow says.

Modern life probably fuels our fears, says Jerilyn Ross. "Maybe as human beings we were not biologically prepared to be up in the sky in a tube or go up 50 stories in a building."

With such a complex grab bag of potential causes, it's not surprising therapists use several approaches to treat anxiety disorders. Medications that work on brain chemistry and interrupt the chain of signals, particularly antidepressants, are effective in treating many anxiety disorders. They are especially helpful when paired with treatment known as cognitive behavioral therapy. Over time, the chain of false alarms and avoidance is broken.

Chad Dyer found the courage to get help for his panic attacks. And, eventually, his therapist sent him alone on a ferry to Martha's Vine-yard to practice what he'd learned. Standing at the edge of an oceanside cliff, he realized he was recovering: "I was 550 miles away from home. I was enjoying the things I was seeing for the first time in eight years and I was not afraid. What a feeling of relief."